Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar
Abstract Background In Myanmar, progress towards malaria elimination has stagnated in some areas requiring deployment of new tools and approaches to accelerate malaria elimination. While there is evidence that networks of community-based malaria workers and insecticide-treated nets (ITNs) can reduce...
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BMC
2025-01-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-024-05241-1 |
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| author | Kyawt Mon Win John E. Gimnig Nay Yi Yi Linn Feliciano Monti Nu Nu Khin William A. Hawley Jimee Hwang Ryan E. Wiegand Ersin Topcuoglu Alexander Moran Khin Lin Hsu Thadar Aye Aye Myint Kyaw Myint Tun |
| author_facet | Kyawt Mon Win John E. Gimnig Nay Yi Yi Linn Feliciano Monti Nu Nu Khin William A. Hawley Jimee Hwang Ryan E. Wiegand Ersin Topcuoglu Alexander Moran Khin Lin Hsu Thadar Aye Aye Myint Kyaw Myint Tun |
| author_sort | Kyawt Mon Win |
| collection | DOAJ |
| description | Abstract Background In Myanmar, progress towards malaria elimination has stagnated in some areas requiring deployment of new tools and approaches to accelerate malaria elimination. While there is evidence that networks of community-based malaria workers and insecticide-treated nets (ITNs) can reduce malaria transmission in a variety of settings, evidence for the effectiveness of other interventions, such as topical repellents, is limited. Since malaria transmission in Myanmar occurs outdoors, mainly among forest-goers, this study tested the effectiveness of topical repellents in combination with supplemental ITN distribution and strengthened networks of malaria workers. Methods Thirty-eight villages in the Tanintharyi Region and Rakhine State were initially selected for the study based on malaria incidence in previous years. An additional 31 villages were included as comparison areas. The implementation of interventions began in March 2020 and continued through June 2021. Malaria cases were detected in all villages through surveillance at health facilities and a network of malaria workers. Data were analysed by interrupted time series. A nested case–control study was also conducted where forest-goers who tested positive for malaria by RDT were matched to up to three forest-goers who tested negative. Results A decrease in mean monthly incidence was observed in the intervention villages from 6.0 (95% CI 4.9–7.1) to 3.7 (95% CI 2.4–4.9) cases per 1000 people at risk before and after the interventions. For the comparison villages, the mean monthly incidence increased from 1.1 (95% CI 0.8–1.5) to 5.7 (95% CI 2.1–9.3) cases per 1000 people at risk. Malaria incidence was significantly lower following the implementation of the interventions (RR = 0.117; 95% CI 0.061–0.223; p < 0.001) in the intervention villages, whereas that of comparison villages was higher after the implementation of the interventions (RR = 3.558; 95% CI 0.311–40.750; p = 0.308). However, a significant trend for increasing malaria incidence after implementation was observed in the intervention villages (RR = 1.113; 95% CI 1.021–1.214, p = 0.015), suggesting a waning effect. The nested case–control analysis showed that the odds of topical repellent use were significantly lower among cases than controls (aOR: 0.063, 95% CI 0.013–0.313, p < 0.001). Conclusion The tailored intervention package for forest-goers helped reduce malaria incidence in Myanmar. Topical repellents may help to further reduce malaria transmission in elimination settings where high-risk populations such as forest-goers do not have easy access to routine health services or are less likely to use ITNs for malaria prevention. |
| format | Article |
| id | doaj-art-396816f54e5343099a01cb4e6ae893c8 |
| institution | Kabale University |
| issn | 1475-2875 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Malaria Journal |
| spelling | doaj-art-396816f54e5343099a01cb4e6ae893c82025-01-12T12:08:59ZengBMCMalaria Journal1475-28752025-01-0124111010.1186/s12936-024-05241-1Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in MyanmarKyawt Mon Win0John E. Gimnig1Nay Yi Yi Linn2Feliciano Monti3Nu Nu Khin4William A. Hawley5Jimee Hwang6Ryan E. Wiegand7Ersin Topcuoglu8Alexander Moran9Khin Lin10Hsu Thadar11Aye Aye Myint12Kyaw Myint Tun13Department of Public Health, National Malaria Control ProgrammeEntomology Branch, U.S. Centers for Disease Control & PreventionDepartment of Public Health, National Malaria Control ProgrammeU.S. President’s Malaria Initiative, U.S. Agency for International DevelopmentU.S. President’s Malaria Initiative, U.S. Agency for International DevelopmentEntomology Branch, U.S. Centers for Disease Control & PreventionU.S. President’s Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control & PreventionDivision of Parasitic Diseases, U.S. Centers for Disease Control & PreventionPMI Defeat Malaria Activity, University Research Co., LLCPMI Defeat Malaria Activity, University Research Co., LLCPMI Defeat Malaria Activity, University Research Co., LLCPMI Defeat Malaria Activity, University Research Co., LLCDepartment of Public Health, National Malaria Control ProgrammePMI Defeat Malaria Activity, University Research Co., LLCAbstract Background In Myanmar, progress towards malaria elimination has stagnated in some areas requiring deployment of new tools and approaches to accelerate malaria elimination. While there is evidence that networks of community-based malaria workers and insecticide-treated nets (ITNs) can reduce malaria transmission in a variety of settings, evidence for the effectiveness of other interventions, such as topical repellents, is limited. Since malaria transmission in Myanmar occurs outdoors, mainly among forest-goers, this study tested the effectiveness of topical repellents in combination with supplemental ITN distribution and strengthened networks of malaria workers. Methods Thirty-eight villages in the Tanintharyi Region and Rakhine State were initially selected for the study based on malaria incidence in previous years. An additional 31 villages were included as comparison areas. The implementation of interventions began in March 2020 and continued through June 2021. Malaria cases were detected in all villages through surveillance at health facilities and a network of malaria workers. Data were analysed by interrupted time series. A nested case–control study was also conducted where forest-goers who tested positive for malaria by RDT were matched to up to three forest-goers who tested negative. Results A decrease in mean monthly incidence was observed in the intervention villages from 6.0 (95% CI 4.9–7.1) to 3.7 (95% CI 2.4–4.9) cases per 1000 people at risk before and after the interventions. For the comparison villages, the mean monthly incidence increased from 1.1 (95% CI 0.8–1.5) to 5.7 (95% CI 2.1–9.3) cases per 1000 people at risk. Malaria incidence was significantly lower following the implementation of the interventions (RR = 0.117; 95% CI 0.061–0.223; p < 0.001) in the intervention villages, whereas that of comparison villages was higher after the implementation of the interventions (RR = 3.558; 95% CI 0.311–40.750; p = 0.308). However, a significant trend for increasing malaria incidence after implementation was observed in the intervention villages (RR = 1.113; 95% CI 1.021–1.214, p = 0.015), suggesting a waning effect. The nested case–control analysis showed that the odds of topical repellent use were significantly lower among cases than controls (aOR: 0.063, 95% CI 0.013–0.313, p < 0.001). Conclusion The tailored intervention package for forest-goers helped reduce malaria incidence in Myanmar. Topical repellents may help to further reduce malaria transmission in elimination settings where high-risk populations such as forest-goers do not have easy access to routine health services or are less likely to use ITNs for malaria prevention.https://doi.org/10.1186/s12936-024-05241-1Forest-goersMalariaMyanmarTailored forest packageTopical repellent |
| spellingShingle | Kyawt Mon Win John E. Gimnig Nay Yi Yi Linn Feliciano Monti Nu Nu Khin William A. Hawley Jimee Hwang Ryan E. Wiegand Ersin Topcuoglu Alexander Moran Khin Lin Hsu Thadar Aye Aye Myint Kyaw Myint Tun Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar Malaria Journal Forest-goers Malaria Myanmar Tailored forest package Topical repellent |
| title | Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar |
| title_full | Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar |
| title_fullStr | Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar |
| title_full_unstemmed | Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar |
| title_short | Effectiveness of a tailored forest package of interventions, including topical repellents, in reducing malaria incidence in Myanmar |
| title_sort | effectiveness of a tailored forest package of interventions including topical repellents in reducing malaria incidence in myanmar |
| topic | Forest-goers Malaria Myanmar Tailored forest package Topical repellent |
| url | https://doi.org/10.1186/s12936-024-05241-1 |
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